Acta Neurochirurgica

, Volume 151, Issue 3, pp 277–284 | Cite as

Spinal intradural primary germ cell tumour—review of literature and case report

  • Ahitagni Biswas
  • Tarun Puri
  • Shikha Goyal
  • Ruchika Gupta
  • Muneer Eesa
  • Pramod Kumar Julka
  • Goura Kishor Rath
Short Illustrated Review



Primary spinal cord germ cell tumour is a rare tumour. We herein review the tumour characteristics, associated risk factors, treatment policy, and patterns of failure of primary intradural germ cell tumour.


We conducted a PUBMED search using a combination of keywords such as “spinal germ cell tumor,” “germinoma,” “extradural,” “intradural,” “intramedullary,” “extramedullary,” and identified 19 cases of primary spinal germ cell tumour. Clinical features, pathologic characteristics, and treatment details of these patients including status at follow-up were noted from respective case reports. We also describe a case of a young Indian patient of intradural extramedullary germ cell tumour treated with a combination of surgery, chemotherapy, and radiotherapy.


The median age at presentation was 24 years. The most common location of the tumour was thoracic (40%). β-HCG overproduction was noted in 40% of the patients. Most patients were treated with a combination of surgery, radiation therapy, and systemic chemotherapy. Median follow-up was 16.5 months. Recurrence was observed in 10% of the patients, all in β-HCG over-producing tumours. The illustrative case was a 28-year male, presenting with pain in lower back and both lower limbs for 2 months. Magnetic resonance imaging spine showed an inhomogeneous hyperintense soft tissue mass at L2-L4 spinal level. He was treated with complete surgical excision and four cycles of chemotherapy with BEP regimen following a histological diagnosis of non-seminomatous germ cell tumour. Palliative irradiation to the lumbar spine was given on progression at 3 months. The patient eventually succumbed to his condition, due to compressive transverse myelitis possibly due to cervical cord metastasis.


Limited surgery followed by upfront radiation therapy and adjuvant chemotherapy is the optimal management of this rare group of tumour. Omission of radiation therapy from the treatment armamentarium might engender local recurrence and spinal dissemination at first failure.


Spinal cord Germ cell tumour Intradural Extramedullary Metastasis 



beta human chorionic gonadotrophin


alpha fetoprotein


octamer 4


placental alkaline phosphatase

CD 30

cluster of differentiation 30


epithelial membrane antigen


syncitiotrophoblastic giant cell


gadolinium diethylenetriamine penta-acetic acid

HMB 45

human melanoma black 45


thyroid transcription factor-1


fluorine-18 fluorodeoxyglucose positron emission tomography/ computed tomography


lactate dehydrogenase


mili international unit


magnetic resonance imaging


cerebrospinal fluid


central nervous system


bleomycin, etoposide, cisplatin


cis-diamminedichloro platinum


craniospinal irradiation


total spinal irradiation






ifosfamide, cisplatin/ carboplatin, etoposide


  1. 1.
    Aoyama T, Hida K, Ishii N, Seki T, Ikeda J, Iwasaki Y (2007) Intramedullary spinal cord germinoma—2 case reports. Surg Neurol 67:177–183PubMedCrossRefGoogle Scholar
  2. 2.
    Balmaceda C (2000) Chemotherapy for intramedullary spinal cord tumours. J Neurooncol 47:293–307PubMedCrossRefGoogle Scholar
  3. 3.
    Bamberg M, Kortmann RD, Calaminus G, Becker G, Meisner C, Harms D, Gobel U (1999) Radiation therapy for intracranial germinoma: results of the German cooperative prospective trials MAKEI 83/86/89. J Clin Oncol 17:2585–2592PubMedGoogle Scholar
  4. 4.
    Borg M (2003) Germ cell tumours of the CNS in children-controversies in radiotherapy. Med Pediatr Oncol 40:367–374PubMedCrossRefGoogle Scholar
  5. 5.
    Chute DJ, Burton EC, Klement IA, Frazee JG, Vinters HV (2003) Primary intramedullary spinal cord germinoma: case report. J Neurooncol 63:69–73PubMedCrossRefGoogle Scholar
  6. 6.
    Dearnaley DP, A’Hern RP, Whittaker S, Bloom HJ (1990) Pineal and CNS germ cell tumours: Royal Marsden Hospital Experience 1962–87. Int J Radiat Oncol Biol Phys 18:773–781PubMedGoogle Scholar
  7. 7.
    Fine HA, Barker FG, Markert JM, Loeffer JS (2005) Neoplasms of the Central Nervous System. In: De vita V et al (eds) Cancer Principles and Practice of Oncology. 7th edition: Lippincott William & Wilkins, pp 1869–1871.Google Scholar
  8. 8.
    Habibi Z, Nejat F, Naeini PE, Mahjoub F (2007) Teratoma inside a myelomeningocele. J Neurosurg 106:467–471PubMedGoogle Scholar
  9. 9.
    Haddock MG, Schild S, Scheithauer BW, Schomberg PJ (1997) Radiation therapy for histologically confirmed primary central nervous system germinoma. Int J Radiat Oncol Biol Phys 38:915–923PubMedGoogle Scholar
  10. 10.
    Hanafusa K, Shibuya H, Abe M, Yamaura K, Suzuki S (1993) Intramedullary spinal cord germinoma: case report and review of the literature. Rofo 159:203–204PubMedGoogle Scholar
  11. 11.
    Hata M, Ogino I, Sakata K, Murata H, Kawano N, Matsubara S (2002) Intramedullary spinal cord germinoma: case report and review of literature. Radiology 223:379–383PubMedCrossRefGoogle Scholar
  12. 12.
    Hisa S, Morinaga S, Kobayashi Y, Ojima M, Chikaoka H, Sasano N (1985) Intramedullary Spinal cord germinoma producing HCG and precocious puberty in a boy. Cancer 55:2845–2849PubMedCrossRefGoogle Scholar
  13. 13.
    Horvath L, McDowell D, Stevens G, Parkinson R, McCarthy S, Boyer M (2001) Unusual presentation of germ cell tumours. Case-2. Seminoma of the conus medullaris. J Clin Oncol 19:911–915PubMedGoogle Scholar
  14. 14.
    Huang JH, Tsui I, Judkins AR, Simon E, Birknes JK, Sutton LN (2004) Intramedullary cervical spine germinoma: case report. Neurosurgery 55:1432PubMedCrossRefGoogle Scholar
  15. 15.
    Inamura T, Nishio S, Ikezaki K, Fukui M (1999) Human chorionic gonadotrophin in CSF, not serum predicts outcome in germinoma. J Neurol Neurosurg Psychiatry 66:654–657PubMedCrossRefGoogle Scholar
  16. 16.
    Itoh Y, Mineura K, Sasajima H, Kowada M (1996) Intramedullary spinal cord germinoma: case report and review of literature. Neurosurgery 38:187–191PubMedCrossRefGoogle Scholar
  17. 17.
    Izquierdo MA, Van der Valk P, Van Ark-Otte J, Rubio G, Germa-Lluch JR, Ueda R, Scheper RJ, Takahashi T, Giaccone G (1995) Differential expression of the c-kit proto-oncogene in germ cell tumors. J Pathol 177:253–258PubMedCrossRefGoogle Scholar
  18. 18.
    Kawano K, Tsujimura T (1995) Intramedullary spinal cord germinoma. Arch Histopathol D D 2:52–54Google Scholar
  19. 19.
    Kiyuna M, Toda T, Sadi AM, Toyoda Z, Nakashima Y (1999) A rare case of extramedullary spinal cord germinoma. Pathol Int 49:633–637PubMedCrossRefGoogle Scholar
  20. 20.
    Lantor PL, Louis DN, Rosenblum MK (2002) Germ cell tumours. In: Graham D, Lantor PL (eds) Greenfields’ Neuropathology. 7th edn. Arnold, London, pp 944–945Google Scholar
  21. 21.
    Matsuoka S, Itoh M, Shinonome T, Tanimura A (1995) Intramedullary spinal cord germinoma: case report. Surg Neurol 35:122–126CrossRefGoogle Scholar
  22. 22.
    Matsuyama Y, Nagasaka T, Mimatsu K, Inoue K, Mii K, Iwata H (1995) Intramedullary spinal cord germinoma. Spine 20:2338–2340PubMedCrossRefGoogle Scholar
  23. 23.
    Michalski JM (2004) Spinal Canal. In: Perez CA et al (eds) Principles and Practice of Radiation Oncology. 4th edition. Lippincott William & Wilkins, pp 860–874Google Scholar
  24. 24.
    Miyanohara O, Takeshima H, Kaji M, Hirano H, Sawamura Y, Kochi M, Kuratsu J (2002) Diagnostic significance of soluble c-kit in the cerebrospinal fluid of patients with germ cell tumours. J Neurosurg 97:177–183PubMedGoogle Scholar
  25. 25.
    Miyauchi A, Matsumoto K, Kohmura E, Doi T, Hashimoto K, Kawano K (1996) Primary intramedullary spinal cord germinoma. J Neurosurg 84:1060–1061PubMedGoogle Scholar
  26. 26.
    Modak S, Gardner S, Dunkel IJ, Balmaceda C, Rosenblum MK, Miller DC, Halpern S, Finlay JL (2004) Thiotepa-based high-dose chemotherapy with autologous stem-cell rescue in patients with recurrent or progressive CNS germ cell tumours. J Clin Oncol 22:1934–1943PubMedCrossRefGoogle Scholar
  27. 27.
    Mostofi FK (1973) Testicular tumors. Epidemiologic, a etiologic and pathologic features. Cancer 32:1186–1201PubMedCrossRefGoogle Scholar
  28. 28.
    Nagasawa S, Kikuchi H, Yamashita J, Mitsuno K (1991) Intracranial and spinal germinomas occurring 4 years after spinal cord germinoma—case report. Neurol Med Chir (Tokyo) 31:729–731CrossRefGoogle Scholar
  29. 29.
    Nakata Y, Yagishita A, Arai N (2006) Two patients with intraspinal germinoma associated with Klinefelter’s syndrome: Case report and review of literature. AJNR Am J Neuroradiol 27:1204–1210PubMedGoogle Scholar
  30. 30.
    Niehans GA, Manivel JC, Copland GT, Scheithauer BW, Wick MR (1988) Immunohistochemistry of germ cell and trophoblastic neoplasms. Cancer 62:1113–1123PubMedCrossRefGoogle Scholar
  31. 31.
    Sasaki T, Amano T, Takao M, Shibata M, Shigematsu N, Fukuuchi Y (2002) A case of intramedullary spinal cord tumour producing human chorionic gonadotrophin. J Nerooncol 56:247–250CrossRefGoogle Scholar
  32. 32.
    Sawamura Y, de Tribolet N, Ishii N, Abe H (1997) Management of primary intracranial germinoma: diagnostic surgery or radical resection? J Neurosurg 87:262–266PubMedCrossRefGoogle Scholar
  33. 33.
    Shirato H, Nishio M, Sawamura Y, Myohjin M, Kitahara T, Nishioka T, Mizutani Y, Abe H, Miysaka K (1997) Analysis of long term treatment of intracranial germinoma. Int J Radiat Oncol Biol Physics 37:511–515Google Scholar
  34. 34.
    Slagel DD, Goeken JA, Platz CA, Moore SA (1995) Primary germinoma of the spinal cord: A case report with 28 year follow-up and review of literature. Acta Neuropathol (Berl) 90:657–659CrossRefGoogle Scholar
  35. 35.
    Takahashi M, Koyama H, Matsubara T, Murata H, Miura K, Nagano A (2006) Mixed germinoma and choriocarcinoma in the intramedullary spinal cord: case report and review of literature. J Neurooncology 76:71–75CrossRefGoogle Scholar
  36. 36.
    Tanaki H, Matsutani M, Funada N (1989) Intracranial choriocarcinoma and germinoma with syncitiotrophoblastic giant cell: report of two cases. Nerv Syst Children 14:251–257Google Scholar
  37. 37.
    Ueda A, Tamura K, Miyazaki H, Ishiyama N (1996) A case report of germinoma with syncytiotrophoblastic giant cell [STGC] in the basal ganglia. No Shinkei Geka 24:267–271PubMedGoogle Scholar
  38. 38.
    Uematsu Y, Tsuura Y, Miyamoto K, Itakura T, Hayashi S, Komai N (1992) The recurrence of primary intracranial germinomas: special reference to germinoma with STGC (syncytiotrophoblastic giant cell). J Neurooncol 13:247–256PubMedCrossRefGoogle Scholar
  39. 39.
    Ulbright TM, Roth LM, Brodhecker CA (1986) Yolk sac differentiation in germ cell tumors: A morphologic study of 50 cases with emphasis on hepatic, enteric, and parietal yolk sac features. Am J Surg Pathol 10:151–164PubMedCrossRefGoogle Scholar
  40. 40.
    Wolden SL, Wara WM, Larson DA, Prados MD, Edwards MS, Sneed PK (1995) Radiation therapy for primary intracranial germ cell tumours. Int J Radiat Oncol Biol Phys 32:943–949PubMedGoogle Scholar
  41. 41.
    Zhu J, Gao Y, Zheng W, Yang J (2002) Intramedullary spinal cord germinoma: a case report. Chin Med J (Engl) 115:1418–1419Google Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Ahitagni Biswas
    • 1
    • 4
  • Tarun Puri
    • 1
  • Shikha Goyal
    • 1
  • Ruchika Gupta
    • 2
  • Muneer Eesa
    • 3
  • Pramod Kumar Julka
    • 1
  • Goura Kishor Rath
    • 1
  1. 1.Department of RadiotherapyAll India Institute of Medical SciencesNew DelhiIndia
  2. 2.Department of PathologyAll India Institute of Medical SciencesNew DelhiIndia
  3. 3.Department of RadiologyAll India Institute of Medical SciencesNew DelhiIndia
  4. 4.Department of Radiation OncologyAll India Institute of Medical SciencesNew DelhiIndia

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